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Overview
Urinary control relies on the finely coordinated activities of the smooth muscle tissue of the urethra and bladder, skeletal muscle, voluntary inhibition, and the autonomic nervous system. Urinary incontinence can result from anatomic, physiologic, or pathologic (disease) factors. Congenital and acquired disorders of muscle innervation (e.g., ALS, spina bifida, multiple sclerosis) eventually cause inadequate urinary storage or control.
The U.S. Department of Health and Human Services reported in 1996 that 13 million people in the United States suffer from urinary incontinence. The condition is far more prevalent in women than men. In the general population aged 15 to 64 years old, 10-30% of women versus 1.5-5% of men are affected. At least 50% of nursing home residents are affected. Of that number, 70% are women.
Of the several types of urinary incontinence, stress, urge, and mixed incontinence account for more than 90% of cases. Overflow incontinence is more common in people with disorders that affect the nerve supply originating in the upper portion of the spinal cord and older men with BPH. The primary characteristics of these types are as follows:
• Stress -- urine loss during physical activity that increases abdominal pressure (e.g., coughing, sneezing, laughing);
• Urge -- urine loss with urgent need to void and involuntary bladder contraction (also called overactive bladder);
• Mixed -- both stress and urge incontinence;
• Overflow -- constant dribbling of urine; bladder never completely empties.
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